Community mental health services have been criticised for seeing those with minor psychiatric disorders at the expense of those with severe and long-term illness. We report a cross-sectional evaluation of a UK service based entirely within the community. Most patients in contact with the service (66%) had a psychotic disorder or an affective disorder. Patients with greater impairment were likely to receive more intensive treatment. Only 20% of the community psychiatric nurse (CPN) case load focused on acute distress and neurotic disorders. Within this service careful operational planning and maintaining CPNs within the secondary care system appear to be critical factors in achieving the goal of giving priority to the severely mentally ill.
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